1. Field
The present application generally relates to vascular remodeling devices and to the manner of their positioning in vessels, and, more particularly, to the manner of their positioning at the junction of neurovascular bifurcations having an aneurysm.
2. Description of Related Art
Neurovascular or cerebral aneurysms affect about 5% of the population. Aneurysms may be located, for example, along arterial side walls (e.g., the aneurysm 10 illustrated in FIG. 1) and at arterial bifurcations (e.g., the aneurysm 20 illustrated in FIG. 2). The direction of fluid flow is generally indicated by the arrows 16, 26. The aneurysms 10, 20 each have a fundus 12, 22, a neck 14, 24, and a fundus-to-neck ratio or “neck ratio.” If the neck ratio is greater than 2 to 1 or if the neck 14, 24 is less than 4 mm, the aneurysm 10, 20 can be treated with embolization coils alone because the coils will generally constrain themselves within the aneurysm 10, 20 without dislodging into parent vessels. If the neck ratio is less than 2 to 1 or if the neck 14, 24 is greater than 4 mm, the aneurysms 10, 20 can be difficult to treat with embolization coils alone because the coils can be prone to dislodging into parent vessels, as illustrated in FIGS. 3A and 3B. Dislodging, prolapse, or herniation of coils can cause arterial occlusion, stroke, and/or death. Compared to the bifurcation illustrated in FIG. 2, the efferent vessels of the bifurcation can be at substantially different angles, have substantially different sizes, and/or be a different quantity (e.g., three or more). Compared to the bifurcation illustrated in FIG. 2, the aneurysm 20 of the bifurcation can be offset with respect to the junction (e.g., having a neck substantially open to one efferent vessel), tilted with respect to a plane created by the vessels (e.g., into or out of the page), etc. Each of these would still be accurately characterized as a “bifurcation” herein.
In order to inhibit such dislodging, tubular neck remodeling devices, for example Neuroform™, available from Boston Scientific, and Enterprise™, available from Cordis Neurovascular, can be used to keep coils or other materials within the fundus of the aneurysm and out of the vessels. Tubular remodeling devices generally consist of a braided wire or cut metallic stent or stents covering the neck of the aneurysm so that materials introduced into the fundus of the aneurysm do not dislodge out of the aneurysm.
As illustrated in FIG. 4A, tubular remodeling devices 40 are generally useful for side wall aneurysms 10. As illustrated in FIGS. 4B and 4C, tubular remodeling devices 42, 44 are generally less useful for aneurysms 20 at bifurcations, for example because shaping the remodeling devices to preserve blood flow through the afferent and efferent vessels while also inhibiting dislodging of coils 28 out of the aneurysm 20 can be difficult.